Mesothelioma Treatment

Quick Summary

The most common mesothelioma treatments are surgery, chemotherapy, and radiation. These treatments play a key role in destroying or reducing cancer tumors. Some patients also receive emerging treatments through clinical trials, which may give them a higher chance of survival. Veterans with mesothelioma can access top doctors and cutting-edge treatment through the VA.

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What Are My Mesothelioma Treatment Options?

Treatment options for mesothelioma vary based on the location of the cancer, the cell type of the cancer, and the patient’s general health. However, most patients will receive at least one of the following treatment options.

Standard treatment options for mesothelioma are:

  • Surgery
  • Chemotherapy
  • Radiation

All three treatment types can be used to extend lifespan or to reduce symptoms and improve quality of life. Your doctor will help you create the best treatment plan for your goals and needs.

Multimodal Treatment for Mesothelioma

Doctors often use a range of therapies simultaneously to help combat mesothelioma. This is called multimodal treatment. Through multimodal treatment, cancer cells left behind by one type of treatment may be destroyed by another.

The most common type of multimodal treatment combines surgery with either radiation or chemotherapy.

Surgery removes most of the cancerous tissue. The other therapies reduce the size of the tumor before surgery or kill remaining cancer cells after surgery takes place.

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Pleural Mesothelioma Treatment

Pleural mesothelioma originates in the lining of the lungs (pleura). It’s the most common form of mesothelioma, giving patients many options for treatment.

Surgery

Mesothelioma surgery is considered the best option for patients seeking curative treatment because it works to remove the cancer in its entirety.

However, it may not be an option for everyone. Invasive surgeries can take a toll on the body and require long recovery times.

Surgery is most often considered for patients diagnosed in the early stages of pleural mesothelioma. Here, the cancer is still easily removable and hasn’t spread to distant areas of the body.

In later stages of the cancer, surgery may be considered too risky. Additionally, some patients may be excluded on the basis of age or poor overall health.

Qualifying patients typically receive one of two pleural mesothelioma surgeries.

1. Extrapleural Pneumonectomy (EPP)

Extrapleural Pneumonectomy

The diagram above illustrates an EPP surgery. This surgery involves removing the affected lung and sometimes the pericardium and a piece of the diaphragm.

Extrapleural pneumonectomy (EPP) removes as much cancerous tissue from the chest cavity as possible. Surgeons remove the affected lung, the lining of the lungs, the lining of the heart, and parts of the diaphragm.

Cancer patients must be in good general health to qualify for this surgery as it is very aggressive. Patients may also face quality of life issues after it is performed, like shortness of breath or dependence on an oxygen tank.

2. Pleurectomy/Decortication (P/D)

Pleurectomy With Decortication

During a P/D, doctors remove the lining of the affected lung as well as visible tumors. The lung itself is not removed.

Pleurectomy with decortication (P/D) removes cancerous tissue from the lining of the heart, lining of the lung, and diaphragm.The lung is left intact and is not removed.

A patient’s age does not affect their ability to receive a P/D. Many oncologists (cancer doctors) prefer it to an EPP even for younger patients since it offers many of the same benefits without the risks to quality of life.

Chemotherapy

Chemotherapy is the most common form of treatment for pleural mesothelioma patients. Age and health do not limit who can receive chemotherapy in most cases. It may be given alone as part of a palliative treatment plan or as part of a multimodal plan to increase lifespan.

Pleural mesothelioma patients who undergo chemotherapy are usually given a combination of cisplatin and pemetrexed.

Radiation

During mesothelioma radiation, high-energy particles and rays are aimed at tumors. This destroys and damages cancer cells so they cannot reproduce. This causes the tumors to shrink, making them easier to remove with surgery. It also slows the spread of cancer.

Radiation therapy is considered non-invasive and is often a top choice for mesothelioma patients. It’s a popular option for palliative care because it can ease painful mesothelioma symptoms.

Palliative Care

Palliative treatment options may be performed to remove a portion of the tumor or to decrease fluid build-up, both of which may cause chest pain and discomfort.

Common palliative options for pleural mesothelioma are:

  • Pleurodesis: Prevents fluid buildup in the pleura (pleural effusions)
  • PleurX™ catheter: Allows patients to drain pleural effusions from home
  • Thoracentesis: Removes excess fluid between the lungs and the pleura

Peritoneal Mesothelioma Treatment

Peritoneal mesothelioma originates in the lining of the abdomen (peritoneum). This type of mesothelioma accounts for 30% of all cases, making it the second most common form. Treatments aim to remove cancer from the peritoneum and other nearby organs.

Surgery

Surgery may be used if the patient has been diagnosed early and they are in good health. As much cancerous tissue as possible is removed, slowing tumor growth and encouraging remission.

Cytoreduction With HIPEC

Cytoreduction with HIPEC is the most notable surgery for peritoneal mesothelioma.

It is a two-step process:

  1. Doctors perform cytoreductive surgery to remove the tumors in the abdomen.
  2. Then, the surgery site is bathed in hyperthermic intraperitoneal chemotherapy, or HIPEC. HIPEC is meant to kill any cancer cells left behind to reduce the risk of recurrence (where the cancer comes back).

Further, warming the chemotherapy reduces its side effects. This, and the fact that HIPEC is directly applied to the surgery site, means a higher dosage can be given safely.

Chemotherapy

Outside of HIPEC, chemotherapy may also be used alone to treat peritoneal mesothelioma. The chemotherapy drugs are used to target and kill cancer cells within the abdomen.

Palliative Care

One palliative treatment for peritoneal mesothelioma patients is a paracentesis. This removes fluid buildup from the abdomen, decreasing bloating and discomfort.

Other Mesothelioma Treatment Options

Different areas of the body require different treatment methods. This is because the tissues and organs near the tumor vary widely depending on where it’s located. Pericardial mesothelioma — which forms in the lining of the heart — and testicular mesothelioma both require specific treatments.

Treatment of Rare Mesothelioma Types

A pericardiectomy is a surgical option for patients with pericardial mesothelioma. This procedure surgically removes the lining of the heart (pericardium).

Since pericardial mesothelioma is often diagnosed in its later stages, many patients with the cancer undergo a pericardiocentesis. This palliative treatment empties excess fluid in the pericardium.

Testicular mesothelioma is often treated with an orchidectomy. This surgery removes one or both of the testicles, preventing the cancer from spreading. A partial orchiectomy may be performed in cases where only part of the testicle needs to be removed.

Alternative Mesothelioma Treatment

There are alternative treatments available for patients with mesothelioma. Although these methods may be somewhat helpful, they are not a substitute for medical care.

Alternative treatments for mesothelioma include:

  • Exercise
  • Herbal therapies
  • Meditation and breathing techniques
  • Well-balanced diet
  • Yoga

These lifestyle changes are often effective in increasing quality of life. They work to reduce stress and bolster general well-being. Patients also report many positive mental and physical health benefits.

New Mesothelioma Treatment Options

There are new and emerging treatments becoming available for mesothelioma patients all the time. Many of these new therapies can treat this cancer in ways the standard options cannot.

New mesothelioma treatment options include:

  • Gene therapy: Specific genes are injected into patients to stop cancerous cell growth.
  • Photodynamic therapy: Patients receive a two-step regimen, consisting of a light-sensitive medicine and a light source, designed to kill cancer cells.
  • Targeted therapy: Certain genes and proteins that help cancer cells divide are targeted and destroyed. This kills existing cells and prevents new ones from forming.

Clinical trials are a great way to access new treatments like these. The treatment methods used in clinical trials are still being researched, but they are still important in the fight against mesothelioma.

Patients who are interested in participating in a clinical trial should speak to their cancer care teams.

Mesothelioma Immunotherapy

Immunotherapy uses medications to stimulate the body’s immune system so it can fight cancer cells more effectively. Immunotherapy medications can increase the immune system response in several ways.

Some drugs, such as Yervoy® (generic name ipilimumab), enhance the body’s ability to make T-cells, which the body generates to fight diseases like cancer. Others, like Opdivo® (generic name nivolumab), help the body’s T-cells target cancer cells more effectively.

Did you know

In October 2020, the Food and Drug Administration (FDA) approved a combination of Opdivo and Yervoy for pleural patients. This marked the first mesothelioma treatment given clearance by the FDA in nearly 20 years.

How To Access Treatment for Mesothelioma Cancer

Determining where and how to access treatment can be difficult, as mesothelioma is rare and hard to diagnose.

A mesothelioma doctor at a specialized cancer center can help patients get properly diagnosed and treated.

Mesothelioma Doctors

Veterans facing a mesothelioma diagnosis should know that the United States Department of Veterans Affairs (VA) works with some of the top mesothelioma specialists in the country. These doctors dedicate their time and experience to helping veterans from all over the United States.

Top mesothelioma doctors who work with veterans include:

  • Dr. Avi Lebenthal

    A thoracic surgeon and director of Minimally Invasive Thoracic Surgery specializing in pleural mesothelioma in Boston.

  • Dr. Paul Sugarbaker

    One of the top peritoneal mesothelioma doctors in the country and a leading proponent of cytoreduction with HIPEC based in Washington, D.C.

  • Dr. Robert Cameron

    A pleural mesothelioma surgeon who developed the lung-sparing P/D surgical procedure in Los Angeles.

Visit the UCLA Health website to learn more about Dr. Robert Cameron.

Disclaimer

The Mesothelioma Veterans Center has no affiliation with and is not endorsed or sponsored by Dr. Robert B. Cameron. The contact information above is listed for informational purposes only. You have the right to contact Dr. Cameron directly.

Mesothelioma Treatment Centers

There are also VA treatment centers around the country that specialize in mesothelioma. These centers have access to cutting-edge treatment options and state-of-the-art equipment.

VA mesothelioma centers include:

Many VA medical centers also provide free, temporary housing for veterans and their loved ones while treatment is occurring.

To access health care through the VA, or to receive other compensation and support, file for VA benefits.

Getting VA Benefits can be simple.

  • VA Disability Claims
  • Survivor Benefits
  • Finding Veteran Doctors

Help with VA Benefits

Common Questions About Mesothelioma Treatment

Top Question

Can mesothelioma be cured?

While there is not yet a cure for mesothelioma, there have been cases of patients who have entered remission and survived well past their projected life expectancy.

Mesothelioma progresses differently in every patient. While average mesothelioma survival rates are statistically fairly low, aggressive treatment and a healthy lifestyle can help extend a patient’s lifespan.

Are there any new treatments for mesothelioma?

New and emerging treatments for mesothelioma are being tested and researched all the time.

The best way to access new treatment options is through clinical trials. Clinical trials study new treatments to help patients live longer and to provide relief to those who haven’t had success with traditional ones.

What is mesothelioma life expectancy without treatment?

The life expectancy of a mesothelioma patient without treatment is around 2-12 months. This is because mesothelioma is aggressive and can spread to distant areas of the body at a rapid rate.

How can I afford mesothelioma treatment?

The cost of mesothelioma treatment can be overwhelming for many patients and their families.

Mesothelioma treatment centers can work with a patient’s insurance company to ensure all medical claims are taken care of. This reduces the stress of dealing with medical costs directly.

Patients without medical insurance still have options. Veterans and civilians with mesothelioma may be eligible for financial compensation to help pay for their medical care.

Financial support programs can be accessed through the VA and other avenues, including asbestos trust funds and settlements.

Request a Free Mesothelioma Veterans Packet to learn more about your compensation options.

Veterans Support Team
Todd Gersten, MD PhotoReviewed by:Todd Gersten, MD

Double Board-Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Todd Gersten, MD is a double board-certified medical oncologist and hematologist specializing in general adult oncology and hematologic disease. He is a physician partner with the Florida Cancer Specialists and practices in Wellington, Florida.

Dr. Todd Gersten is an independently paid medical reviewer.

Christopher Dryfoos PhotoWritten by:

Contributing Author

Christopher Dryfoos is a journalist and member of the American Medical Writers Association (AMWA). As the grandson of the U.S. Navy’s first forensic pathologist, he aims to help veterans with mesothelioma access needed care.

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